EFEK ANALGF,SIA KETAMIN 0,1 mg/Kg BB INTRAVENA TERHADAP NYERI PENYUNTIKAN PROPOFOL

Abstract

Background : Anesthetic induction using propofol induces pain on injection. Intravenous ketamine of 0,1 mg/kg.BW has anal aesic effect. Objective : The purpose of this research was to study the influence of the analgesic effect of 0,1 mg/kg.BW intravenous ketamine on pain induced by intravenous injection of propofol. Methods : This research used a randomized, controlled, double blinded design to study the effect of ketamine on propofol induced pain.Fifty patients, age 18-50 years (ASA physical status I-II) undergoing elective surgery with general anesthesia in Dr Kaniadi Hospital,Semarang were randomly allocated into one of the two groups: Group I (n = 25) received intravenous ketamine 0,1 mg/kg.BW (0,25% solution) three minutes before induction of anesthesia with 2,5 mg/kg BB of 1% propofol, and group If received placebo (NaCl 0,9%) before propofol. Pain score was evaluated usinu four point scale ( 0 = no pain, 1 =-Minimal pain, 2 = moderate pain, 3 = severe pain ). Statistical analyzes was carried out using student t-test, chi square and the Mann-Whitney U test. A p value of < 0,05 was regarded as significant. Results : Different between groups are significant (pc- 0,05) in all four scale of pain score. Group I is higher at no pain and minimal pain, while group II is higher at moderate pain and severe pain. Median pain score is significantly different between groups. Median for group I is <1(0-1) and median for group II is 2 (1-3),at 25-75 percentiles. The incidence of pain is significantly different between groups and it was lowered from 88% in group II to 52 % in group I. Changes in haemodynamic parameters are significantly different between groups after induction of anesthesia. Conclusion : Intravenous ketamine of 0,1 mg /kg BB reduces the incidence and intensity of propofol induced pain with minimal haemodynamic parameter changes. keywords : Anesthetic induction, propofol, pain on injection, ketamine, analgesic effect. Latar belakang : Induksi anestesi dengan propofol intravena sering menyebabkan nyeri penyuntikan. Ketamin 0,1 mg/kg BB intravena mem iliki efek analgesia. Tujuan : Membuktikan apakah pemberian ketamin 0,1 mg/kg BB intravena efektif mengurangi timbulnya nyeri penyuntikan propofol. Metode : Randomisasi dengan disain "pretest posttest control group" terhadap uji klinis yang dilakukan secara acak tersamar ganda dipergunakan meneliti efek analgesia ketamin 0,1 mg/kg BB intravena terhadap nyeri penyuntikan propofol saat induksi pada 50 penderita, usia 18-50 tahun dengan status fisik ASA I-II yang akan menjalani operasi elektif dengan teknik anestesi umum di RS Dr Kariadi Semarang, yang dibagi menjadi dua kelompok. Kelompok I (n = 25) mendapat ketamin 0,1 mg/kg BB intravena (larutan 0,25%) diikuti pemberian propofol 1% (2,5 mg/kg BB) 3 menit kemudian melalui vena dorsum manus. Kelompok II (n = 25) mendapat NaCI 0,9% 3 menit sebelum pemberian propofol. Skor nyeri diukur memakai skala empat nilai ( 0 = tidak nyeri, I = nyeri ringan, 2 = nyeri sedang, 3 = nyeri berat ). Uji statistik dilakukan dengan student t test, chi square dan uji non parametrik Mann-Whitney U test dengan derajat kemaknaan p < 0,05. Basil : Terdapat perbedaan bermakna ( p < 0,05 ) pada keempat skala nyeri di mana kelompok I Iebih tinggi pada skala 0 dan 1 sementara kelompok II Iebih tinggi pada skala 2 dan 3. Median skor nyeri juga berbeda bermakna antara kedua kelompok di mana kelompok I dengan median < 1(0-1) dan kelompok II dengan median 2 (1-3). Insiden nyeri menurun dad 88% pada kelompok II menjadi 52% pada kelompok I. Terdapat perbedaan bermakna dalam perubahan hemodinamik pascahipnosis antara kedua kelompok. Kesimpulan : Ketamin 0,1 mg/kg BB intravena dapat menurunkan insiden dan intensitas nyeri penyuntikan propofol disertai perubahan hemodinamik yang Iebih kecil.